Provider Demographics
NPI:1831618990
Name:PALMENO-GONZALEZ, NICHOLE SABRINA (CNA)
Entity type:Individual
Prefix:MRS
First Name:NICHOLE
Middle Name:SABRINA
Last Name:PALMENO-GONZALEZ
Suffix:
Gender:F
Credentials:CNA
Other - Prefix:
Other - First Name:NICHOLE
Other - Middle Name:SABRINA
Other - Last Name:GORMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CNA
Mailing Address - Street 1:319 N DAY AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKFORD
Mailing Address - State:IL
Mailing Address - Zip Code:61101-5437
Mailing Address - Country:US
Mailing Address - Phone:779-777-0746
Mailing Address - Fax:
Practice Address - Street 1:319 N DAY AVE
Practice Address - Street 2:
Practice Address - City:ROCKFORD
Practice Address - State:IL
Practice Address - Zip Code:61101-5437
Practice Address - Country:US
Practice Address - Phone:779-777-0746
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide